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Kubde D, Badge AK, Ugemuge S, Shahu S. Importance of Hospital Infection Control. Cureus 2023; 15:e50931. [PMID: 38259418 PMCID: PMC10801286 DOI: 10.7759/cureus.50931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 12/21/2023] [Indexed: 01/24/2024] Open
Abstract
The increasing demand for healthcare-acquired infection (HAI) control practices and services has intensified the need to evaluate care quality. The World Health Organization (WHO) introduced an infection prevention and control (IPC) framework to mitigate the impact of HAIs, crucial for ensuring patient safety in hospitals. HAIs acquired after hospitalization pose significant challenges due to factors such as compromised immunity, invasive medical procedures, and antibiotic-resistant pathogens, which have dire consequences, including higher mortality rates and increased healthcare costs. Healthcare workers (HCWs) are critical in implementing IPC measures. Infection control programs that include strategies such as hand hygiene, personal protective equipment (PPE), environmental cleaning, and surveillance have become standard. However, challenges such as resistance to change, resource limitations, patient turnover, and variability in patient conditions persist. Strategies to maintain hospital infection control involve rigorous compliance monitoring, staff education, advanced technologies such as artificial intelligence (AI), machine learning (ML), telemedicine, and innovative sanitation methods. The future of hospital infection control may involve increased integration of environmental monitoring, antimicrobial stewardship, and patient participation while leveraging collaboration among healthcare facilities. The review highlights the criticality of hospital infection control and suggests trends and opportunities to strengthen prevention efforts and patient safety.
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Affiliation(s)
- Dimple Kubde
- School of Allied Health Sciences, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research (DU), Nagpur, IND
| | - Ankit K Badge
- Department of Microbiology, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research (DU), Nagpur, IND
| | - Sarita Ugemuge
- Department of Microbiology, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research (DU), Nagpur, IND
| | - Shivani Shahu
- School of Allied Health Sciences, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research (DU), Nagpur, IND
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Matula E, Mastrocco A, Prittie J, Weltman J, Keyserling C. Microorganism colonization of peripheral venous catheters in a small animal clinical setting. J Vet Emerg Crit Care (San Antonio) 2023; 33:509-519. [PMID: 37585353 DOI: 10.1111/vec.13328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/16/2022] [Accepted: 06/30/2022] [Indexed: 08/18/2023]
Abstract
OBJECTIVE To compare the incidence of microorganism colonization of peripheral venous catheters (PVCs) placed in the Emergency Department (ED) to those placed in a routine preoperative setting. The relationship between catheter tip colonization and patient urgency (as assessed by triage priority) was also evaluated. DESIGN Prospective, observational study from January 2021 to October 2021. SETTING Emergency room and clinical areas of a large, urban, tertiary referral center. ANIMALS Three hundred dogs and 94 cats with a PVC in place for a minimum of 24 hours were enrolled in the study. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Two hundred and eighty-eight PVCs were placed in the ED and 106 were placed preoperatively. The overall colonization rate was 10.4% (41/394). Sixteen bacterial and 1 fungal genera were cultured. Eight of these bacterial genera (25/51 [49%] bacterial isolates) were resistant to at least 1 antimicrobial class. Twenty-nine of 288 (10.1%) catheters positive for colonization were placed in the ED, whereas 12 of 106 (11.3%) were placed preoperatively. There was no association between microorganism growth on catheters and clinical area of catheter placement. There was also no association between ED patient urgency and positive catheter tip culture. No significant risk factors were identified predisposing to colonization of PVCs. CONCLUSIONS The overall incidence of microorganism colonization of PVCs in this study population was equivalent to, or lower than, previously reported in veterinary literature. There was no statistical difference between the catheters placed in the ED and those placed for routine surgical procedures. Patient urgency did not affect the incidence of positivity of peripheral catheter tip cultures.
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Affiliation(s)
- Erica Matula
- Emergency and Critical Care, The Animal Medical Center, New York, New York, USA
| | - Alicia Mastrocco
- Emergency and Critical Care, The Animal Medical Center, New York, New York, USA
| | - Jennifer Prittie
- Emergency and Critical Care, The Animal Medical Center, New York, New York, USA
| | - Joel Weltman
- Emergency and Critical Care, The Animal Medical Center, New York, New York, USA
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Rubasinghe S, Priyadarshani K, Wijesundara P, Ramyamala S, Lakmal K, Bandara A, Dasanayaka R. Knowledge of nosocomial infections, standard precautions, and source of information among physiotherapy undergraduates in Sri Lanka; an observational study. Antimicrob Resist Infect Control 2023; 12:45. [PMID: 37161426 PMCID: PMC10169217 DOI: 10.1186/s13756-023-01248-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 05/01/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND Physiotherapists and physiotherapy undergraduates have direct contact with patients which make them transmitters of infections if they do not follow standard precautions. Hence, the purpose of this study was to assess the knowledge of nosocomial infections, standard precautions, and source of information among physiotherapy undergraduates in Sri Lanka. METHODS An observational Google based survey study was conducted among 294 physiotherapy undergraduates, of which there were 103 in University of Peradeniya, 103 in University of Colombo, and 88 in General Sir John Kotelawala Defence University. The Infection Control Standardized Questionnaire comprising three domains: knowledge of nosocomial infections, standard precautions and hand hygiene was used for data collection along with a self-constructed data sheet for socio-demographic information and source of information. RESULTS Participants achieved mean knowledge of 67.1 ± 16.8, 84.4 ± 14.7 and 66.4 ± 15.4 for nosocomial infections, standard precautions, and hand hygiene respectively. Of the total sample, 225 (76.5%) achieved adequate level of total knowledge. Eighty-three of them (28.3%) equally mentioned, formal teaching at faculty and informal sources as the most important source of knowledge. There was no significant impact of university and the duration of clinical exposure on knowledge of nosocomial infections, standard precautions, hand hygiene and total knowledge. The study year has a significant impact on standard precautions (P = 0.004) and total knowledge (P = 0.035) and final years had highest knowledge compared to the other study years. CONCLUSION Knowledge of nosocomial infections and infection control measures were satisfactory among the physiotherapy undergraduates in Sri Lanka. Further developments of formal sources of information about nosocomial infections are recommended.
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Affiliation(s)
- Sahan Rubasinghe
- Department of Physiotherapy, Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya, 20400, Sri Lanka
| | - Kokila Priyadarshani
- Department of Physiotherapy, Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya, 20400, Sri Lanka
| | - Pramodha Wijesundara
- Department of Physiotherapy, Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya, 20400, Sri Lanka
| | - Singappulige Ramyamala
- Department of Physiotherapy, Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya, 20400, Sri Lanka
| | - Krishantha Lakmal
- Department of Physiotherapy, Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya, 20400, Sri Lanka
| | - Anuradhi Bandara
- Department of Physiotherapy, Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya, 20400, Sri Lanka
| | - Renuka Dasanayaka
- Department of Physiotherapy, Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya, 20400, Sri Lanka.
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Muacevic A, Adler JR, Hussain F, Fazli SA, Mehmood Qadri H, Manzoor N, Cheema MF, Haq AU, Ismail F, Saffi J. Donning Sterile Surgical Gloves - A Prospective Clinical Audit of Young Surgeons at a Tertiary Care Hospital of Lahore, Pakistan. Cureus 2022; 14:e32831. [PMID: 36694490 PMCID: PMC9866157 DOI: 10.7759/cureus.32831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2022] [Indexed: 12/24/2022] Open
Abstract
Background Sterilization and aseptic surgical techniques are the most important keys to successful postoperative outcomes. The standard surgical gloving technique causes early wound healing and reduces morbidity and mortality. Objective To assess the standard technique of donning sterile surgical gloves while scrubbing among young surgeons. Material and Methods This two-week prospective audit involved 60 young residents and house officers after ensuring ethical implications. Participants were observed unannounced for donning sterile surgical gloves in the surgical operation theatre (OT) according to the standard criteria set by World Health Organization (WHO) before and after the relevant intervention. The intervention was made through a clinical lecture, live demonstration, and hands-on sessions. After a detailed literature study, a pro forma was generated to record participants' compliance with 14 steps of donning sterile surgical gloves. Data was sent to a statistician for descriptive analysis. Results About 72.14% of the participants followed the standard criteria of donning sterile surgical gloves before intervention. This percentage raised to 90.71% after the intervention, showing marked improvement. Conclusion Pre-intervention and post-intervention observations showed apparent differences in compliance rates for the standard criteria of donning sterile surgical gloves. This scientific study signifies the need for such clinical audits to boost standard surgical practices, especially among newcomers.
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Bechtold ML, Regunath H, Tyler R, Guenter P, Barrocas A, Collins NA. Impact of a nutrition support therapy on hospital-acquired infections: A value analysis. Nutr Clin Pract 2021; 36:1034-1040. [PMID: 34245487 DOI: 10.1002/ncp.10729] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Hospital-acquired conditions (HACs) have a direct impact on value, as they decrease quality and increase costs. Numerous interventions have been tried, including nutrition support therapy, with unknown effect on value. Therefore, a value analysis of nutrition support therapy on HACs was performed. METHODS An extensive literature search was performed. Using the Medicare Parts A and B Claims 5% Sample data set, analytic claims modeling was conducted. RESULTS The search identified 1099 studies, with eight meeting the inclusion criteria. All studies were performed on adult critically ill patients and focused on HA infections (HAIs) as the HAC. One study underwent Medicare claims modeling and revealed nutrition therapy has the potential of saving at least $104 million annually in Medicare patients with HAIs. CONCLUSION Nutrition support therapy has the potential to reduce costs of Medicare spending in respect to HAIs.
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Affiliation(s)
- Matthew L Bechtold
- Department of Medicine, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Hariharan Regunath
- Department of Medicine, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Renay Tyler
- Ambulatory Services, University of Maryland, Baltimore, Maryland
| | - Peggi Guenter
- American Society for Parenteral and Enteral Nutrition, Silver Spring, Maryland
| | - Albert Barrocas
- Department of Surgery, Tulane University, New Orleans, Louisiana, USA
| | - Nilsa A Collins
- Clinical Integration Programs, WellStar Clinical Partners, Marietta, Georgia
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Patel SN, Gangaputra S, Sternberg P, Kim SJ. Prophylaxis measures for postinjection endophthalmitis. Surv Ophthalmol 2020; 65:408-420. [PMID: 31923477 DOI: 10.1016/j.survophthal.2019.12.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 12/24/2019] [Accepted: 12/30/2019] [Indexed: 12/23/2022]
Abstract
Intravitreal injections have become the most commonly performed ophthalmic procedure, transforming modern retina practice. Postinjection endophthalmitis, while rare, remains the most feared potential complication. Prophylaxis measures including topical antisepsis, hand hygiene, gloves, masks, and drapes have all been proposed to help prevent postinjection endophthalmitis; however, there remains significant variation in protocol, given the lack of agreement among retina specialists on which steps are crucial to prevent endophthalmitis. With millions of injections performed annually, collating data have helped us better understand risk factors for endophthalmitis after intravitreal injection. We summarize the consensus guidelines for intravitreal injection technique and comprehensively review the literature on prevention of postinjection endophthalmitis.
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Affiliation(s)
- Shriji N Patel
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
| | - Sapna Gangaputra
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Paul Sternberg
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Stephen J Kim
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
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Eshetu B, Gashaw M, Berhane M, Abdissa A, McClure EM, Goldenberg RL, Muhe LM. Intravenous fluid contaminated with Klebsiella oxytoca as a source of sepsis in a preterm newborn: Case report. Am J Infect Control 2019; 47:840-842. [PMID: 30723029 DOI: 10.1016/j.ajic.2018.12.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 12/30/2018] [Accepted: 12/31/2018] [Indexed: 11/29/2022]
Abstract
Advances in neonatal care have led to the increasing survival of smaller and sicker infants, but nosocomial infections continue to be a serious problem, associated with increased mortality rates, immediate and long-term morbidity, prolonged hospital stay, and increased cost of care. We report a case of hospital-acquired sepsis in a preterm baby secondary to Klebsiella oxytoca, resulting from contaminated intravenous fluid.
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Affiliation(s)
- Beza Eshetu
- Department of Pediatrics and Child Health, Jimma University, Jimma, Ethiopia.
| | - Mulatu Gashaw
- School of Medical Laboratory Sciences, Jimma University, Jimma, Ethiopia
| | - Melkamu Berhane
- Department of Pediatrics and Child Health, Jimma University, Jimma, Ethiopia
| | - Alemseged Abdissa
- School of Medical Laboratory Sciences, Jimma University, Jimma, Ethiopia
| | - Elizabeth M McClure
- Social, Statistical and Environmental Health Sciences, RTI International, Research Triangle Park, NC
| | - Robert L Goldenberg
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY
| | - Lulu M Muhe
- Department of Pediatrics and Child Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia; Maternal, Newborn, Child Health and Childhood HIV, TB and Malaria, Geneva, Switzerland
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Licina D, Morrison GC, Bekö G, Weschler CJ, Nazaroff WW. Clothing-Mediated Exposures to Chemicals and Particles. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2019; 53:5559-5575. [PMID: 31034216 DOI: 10.1021/acs.est.9b00272] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
A growing body of evidence identifies clothing as an important mediator of human exposure to chemicals and particles, which may have public health significance. This paper reviews and critically assesses the state of knowledge regarding how clothing, during wear, influences exposure to molecular chemicals, abiotic particles, and biotic particles, including microbes and allergens. The underlying processes that govern the acquisition, retention, and transmission of clothing-associated contaminants and the consequences of these for subsequent exposures are explored. Chemicals of concern have been identified in clothing, including byproducts of their manufacture and chemicals that adhere to clothing during use and care. Analogously, clothing acts as a reservoir for biotic and abiotic particles acquired from occupational and environmental sources. Evidence suggests that while clothing can be protective by acting as a physical or chemical barrier, clothing-mediated exposures can be substantial in certain circumstances and may have adverse health consequences. This complex process is influenced by the type and history of the clothing; the nature of the contaminant; and by wear, care, and storage practices. Future research efforts are warranted to better quantify, predict, and control clothing-related exposures.
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Affiliation(s)
- Dusan Licina
- Human-Oriented Built Environment Lab, School of Architecture, Civil and Environmental Engineering , École Polytechnique Fédérale de Lausanne , CH-1015 Lausanne , Switzerland
| | - Glenn C Morrison
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health , The University of North Carolina at Chapel Hill , Chapel Hill , North Carolina 27599 , United States
| | - Gabriel Bekö
- International Centre for Indoor Environment and Energy, Department of Civil Engineering , Technical University of Denmark , Lyngby 2800 , Denmark
| | - Charles J Weschler
- International Centre for Indoor Environment and Energy, Department of Civil Engineering , Technical University of Denmark , Lyngby 2800 , Denmark
- Environmental and Occupational Health Sciences Institute , Rutgers University , Piscataway , New Jersey 08901 , United States
| | - William W Nazaroff
- Department of Civil and Environmental Engineering , University of California , Berkeley , California 94720-1710 , United States
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Proper Sterile Gloving Technique for Non-Operating Room Sterile Procedures: A Step-by-Step Guide. Ochsner J 2018; 18:293-297. [PMID: 30559610 DOI: 10.31486/toj.17.0119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Boots R. Prevention of Nosocomial Infection in the Neurosciences Intensive Care Unit: Remember the Basics. Neurocrit Care 2018; 25:167-9. [PMID: 27535771 DOI: 10.1007/s12028-016-0314-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Rob Boots
- Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia.
- Burns Trauma and Critical Care Research Centre, University of Queensland, Brisbane, Australia.
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Time Effectiveness of Ultraviolet C Light (UVC) Emitted by Light Emitting Diodes (LEDs) in Reducing Stethoscope Contamination. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13100940. [PMID: 27669273 PMCID: PMC5086679 DOI: 10.3390/ijerph13100940] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 09/07/2016] [Accepted: 09/15/2016] [Indexed: 01/05/2023]
Abstract
Today it is well demonstrated that stethoscopes can be as contaminated as hands, which are a recognized source of Health-Care Associated Infections (HCAIs). Ultraviolet C (UVC) light has proven disinfection capacity and the innovative UVC technology of Light Emitting Diode (LED) shows several potential benefits. To verify whether the use of UVC LEDs is effective and reliable in stethoscope membrane disinfection after prolonged use, a pre-post intervention study was conducted. A total of 1668 five-minute cycles were performed on two UVC LEDs to simulate their use; thereafter, their disinfection capacity was tested on stethoscope membranes used on a previously auscultated volunteer. Then, a further 1249 cycles were run and finally the LEDs were tested to assess performance in reducing experimental contamination by Staphylococcusaureus, Pseudomonasaeruginosa and Escherichia coli on the stethoscope membrane. Baseline volunteer contamination identified 104 Colony Forming Units (CFUs) while treated Petri dishes had 12 and 15 CFUs (p < 0.001). Statistically significant differences (p < 0.001) were also found relating to the reduction of specific bacteria: in particular, after treatment no CFU were observed for S. aureus and E. coli. UVC LEDs demonstrated the capacity to maintain high levels of disinfection after more than 240 h of use and they were effective against common microorganisms that are causative agents of HCAIs.
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Dziri R, Klibi N, Lozano C, Ben Said L, Bellaaj R, Tenorio C, Boudabous A, Ben Slama K, Torres C. High prevalence of Staphylococcus haemolyticus and Staphylococcus saprophyticus in environmental samples of a Tunisian hospital. Diagn Microbiol Infect Dis 2016; 85:136-40. [DOI: 10.1016/j.diagmicrobio.2016.03.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 03/01/2016] [Accepted: 03/05/2016] [Indexed: 11/29/2022]
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A new UV-LED device for automatic disinfection of stethoscope membranes. Am J Infect Control 2015; 43:e61-6. [PMID: 26254501 DOI: 10.1016/j.ajic.2015.06.019] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 06/13/2015] [Accepted: 06/16/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND Stethoscopes are widely used by doctors and nurses. Poor stethoscope hygiene is a potential source of nosocomial infection. This study aimed to propose an innovative solution, based on the latest advances in ultraviolet (UV) light-emitting diodes (LEDs), for disinfecting stethoscope membranes automatically and efficiently. METHODS Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, and Enterococcus faecalis were sown on 28 stethoscope membranes and then transferred to Petri dishes. Treatment involved illuminating exposed Petri dishes with a UVC LED for 1 minute. For each microbe, the number of colony-forming units (cfu) at 36°C was compared in control and treated dishes using the Wilcoxon signed-rank test. The Kruskal-Wallis test was used to assess percent reductions in bacteria. Statistical significance was set at 99%. RESULTS A significant reduction in cfu counts after UV treatment (P < .01) was found for all bacteria: 85.5% for E faecalis, 87.5% for S aureus, 94.3% for E coli, and 94.9% for P aeruginosa . No significant differences in percent reduction in cfu were found between bacteria (P > .01). CONCLUSION The stethoscope, symbol of medicine and health care professionals, has been demonstrated to be a carrier of microorganisms. The treatment technique was effective and efficient in disinfecting the membranes. These promising results represent a step forward toward eliminating stethoscope membrane contamination with an innovative approach.
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Mwamungule S, Chimana HM, Malama S, Mainda G, Kwenda G, Muma JB. Contamination of health care workers' coats at the University Teaching Hospital in Lusaka, Zambia: the nosocomial risk. J Occup Med Toxicol 2015; 10:34. [PMID: 26380579 PMCID: PMC4572668 DOI: 10.1186/s12995-015-0077-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 09/10/2015] [Indexed: 11/25/2022] Open
Abstract
Background Health care Associated Infections (HAIs) are a major public health problem in both developed and developing countries. They pose a severe impact in resource-poor settings, where the rate of infection is estimated to be relatively high. Therefore, this study was conducted to establish empirical evidence related to HAIs in Zambia. Method This was a prospective cross-sectional study conducted from October, 2013 to May 2014 at the University Teaching Hospital (UTH) in Lusaka. A total of 107 white coats worn by health care-workers at UTH were sampled for possible bacteriological contamination. Results Of the 107 white coats screened, 94 (72.8 %) were contaminated with bacteria. There was no difference in the contamination levels between white coats worn for more than 60 min (47.8 %) compared to those worn for 30–60 min (46.7 %) (p = 0.612). Further, the antibiotic sensitivity tests indicated that the bacterial isolates were resistant to some of the antibiotics assessed. Isolates of Staphylococcus aureus and Klebsiella pnumoniae exhibited the highest resistance to most of the antibiotics assessed. Conclusion This study has shown that white coats worn by health care-workers at the University Teaching Hospital generally have high microbial contaminations and hence pose a nosocomial risk. It is therefore, recommended that white coats be regularly sanitized, and health care workers also be sensitized on public health risk of HAIs associated with contaminated coats.
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Affiliation(s)
- Susan Mwamungule
- Department of Biomedical Sciences, School of Medicine, University of Zambia, Lusaka, Zambia
| | - Henry Mwelwa Chimana
- Department of Biomedical Sciences, School of Medicine, University of Zambia, Lusaka, Zambia
| | - Sydney Malama
- Health Promotions Unit, Institute of Economic and Social Research, University of Zambia, Lusaka, Zambia
| | - Geoffrey Mainda
- Department of Disease Control, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
| | - Geoffrey Kwenda
- Department of Biomedical Sciences, School of Medicine, University of Zambia, Lusaka, Zambia
| | - John Bwalya Muma
- Department of Disease Control, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
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Merani R, Hunyor AP. Endophthalmitis following intravitreal anti-vascular endothelial growth factor (VEGF) injection: a comprehensive review. Int J Retina Vitreous 2015; 1:9. [PMID: 27847602 PMCID: PMC5088471 DOI: 10.1186/s40942-015-0010-y] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 06/30/2015] [Indexed: 02/03/2023] Open
Abstract
The purpose of this review is to report and summarize previously reported studies and assess many of the individual steps of the intravitreal injection procedure's possible effect on the prevention of endophthalmitis. The pooled endophthalmitis rate from 20 large retrospective case series of anti-VEGF injections was 144/510,396 (0.028%; 1/3,544). Injections may be performed in an office-based location or in an operating room (OR) and low rates of endophthalmitis can be achieved in either location with careful attention to asepsis. Pre- or post-injection topical antibiotics have not been shown to be effective, and could select for more virulent microorganisms. Povidone-iodine prior to injection is accepted as the gold-standard antiseptic agent, but aqueous chlorhexidine may be an alternative. Antisepsis before and after gel or subconjunctival anesthetic is suggested. The preponderance of Streptococcal infections after intravitreal injection is discussed, including the possible role of aerosolization, which can be minimized by using face masks or maintaining silence. As with other invasive procedures in medicine, the use of sterile gloves, following adequate hand antisepsis, may be considered. Control of the eyelashes and lid margin is required to avoid contamination of the needle, but this can be achieved with or without a speculum. Techniques to minimize vitreous reflux have not been shown to reduce the risk of endophthalmitis. Same day bilateral injections should be performed as two separate procedures, preferably using drug from different lots, especially when using compounded drugs.
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Affiliation(s)
- Rohan Merani
- Retina Associates, Level 4, 8 Thomas St, Chatswood, NSW 2067 Australia
- Save Sight Institute, University of Sydney, Sydney, NSW Australia
- Australian School of Advanced Medicine, Macquarie University, Sydney, NSW Australia
- Concord Repatriation General Hospital, Concord, NSW Australia
| | - Alex P Hunyor
- Retina Associates, Level 4, 8 Thomas St, Chatswood, NSW 2067 Australia
- Save Sight Institute, University of Sydney, Sydney, NSW Australia
- Australian School of Advanced Medicine, Macquarie University, Sydney, NSW Australia
- Sydney Eye Hospital, Sydney, NSW Australia
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Mehmood Z, Mubeen SM, Afzal MS, Hussain Z. Potential risk of cross-infection by tourniquets: a need for effective control practices in pakistan. Int J Prev Med 2014; 5:1119-24. [PMID: 25317294 PMCID: PMC4192773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2013] [Accepted: 03/28/2014] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Tourniquets used repeatedly on patients for blood sampling are a potential source of nosocomial infections. They harbor numerous microorganisms, including methicillin-resistant Staphylococcus aureus (MRSA). The aim of this study was to investigate tourniquets for the presence of microorganisms and to ascertain the infection control practices of health care workers. METHODS A cross-sectional study was carried out in 2012 on 100 samples of tourniquets collected from public and private sector hospitals in Karachi, Pakistan. The samples were cultured, and pathogenic microorganisms were identified and tested for methicillin resistance. A questionnaire was administered simultaneously to 100 health care workers who had used the tourniquets. Descriptive data are represented as frequencies and percentages. Ethical considerations were taken into account. RESULTS The total colonization rate was 51%, with no bacterial growth in 17/40 and 32/60 samples from public and private sector hospitals, respectively. S. aureus was isolated from 12 (42%) private sector hospital samples and 10 (43%) public sector hospital samples. Although MRSA was found in more samples from public than private sector hospitals, the difference was not statistically significant. Nevertheless, 90% of all elastic and 41% of all rubber tourniquets harbored microorganisms (P < 0.001). Although 96% of health care workers agreed that hospital staff and fomites can transmit infection, none identified tourniquets as a potential source. When asked whether tourniquets appeared clean before use, 66% agreed, and only 25% considered that tourniquets should be washed or cleaned before use. CONCLUSIONS Tourniquets are a potential reservoir and vehicle for the spread of nosocomial infections, including MRSA. Health care workers have inadequate knowledge about infection control procedures and personal hygiene for disinfecting reusable items.
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Affiliation(s)
- Zara Mehmood
- Hamdard College of Medicine and Dentistry, Karachi, Pakistan
| | - Syed Muhammad Mubeen
- Department of Community Health Sciences, Hamdard College of Medicine and Dentistry, Karachi, Pakistan,Correspondence to: Prof. Dr. Syed Muhammad Mubeen, Hamdard College of Medicine and Dentistry, Shara-e-Madinat Al-Hikmah, Mohammad Bin Qasim Avenue, Hamdard University, Karachi 74600, Pakistan. E-mail:
| | | | - Zainab Hussain
- Hamdard College of Medicine and Dentistry, Karachi, Pakistan
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Environmental contaminants in hospital settings and progress in disinfecting techniques. BIOMED RESEARCH INTERNATIONAL 2013; 2013:429780. [PMID: 24286078 PMCID: PMC3830765 DOI: 10.1155/2013/429780] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 09/17/2013] [Indexed: 01/22/2023]
Abstract
Medical devices, such as stethoscopes, and other objects found in hospital, such as computer keyboards and telephone handsets, may be reservoirs of bacteria for healthcare-associated infections. In this cross-over study involving an Italian teaching hospital we evaluated microbial contamination (total bacterial count (TBC) at 36°C/22°C, Staphylococcus spp., moulds, Enterococcus spp., Pseudomonas spp., E. coli, total coliform bacteria, Acinetobacter spp., and Clostridium difficile) of these devices before and after cleaning and differences in contamination between hospital units and between stethoscopes and keyboards plus handsets. We analysed 37 telephone handsets, 27 computer keyboards, and 35 stethoscopes, comparing their contamination in four hospital units. Wilcoxon signed-rank and Mann-Whitney tests were used. Before cleaning, many samples were positive for Staphylococcus spp. and coliforms. After cleaning, CFUs decreased to zero in most comparisons. The first aid unit had the highest and intensive care the lowest contamination (P < 0.01). Keyboards and handsets had higher TBC at 22°C (P = 0.046) and mould contamination (P = 0.002) than stethoscopes. Healthcare professionals should disinfect stethoscopes and other possible sources of bacterial healthcare-associated infections. The cleaning technique used was effective in reducing bacterial contamination. Units with high patient turnover, such as first aid, should practise stricter hygiene.
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Uneke CJ, Ndukwe CD, Oyibo PG, Nwakpu KO, Nnabu RC, Prasopa-Plaizier N. Promotion of hand hygiene strengthening initiative in a Nigerian teaching hospital: implication for improved patient safety in low-income health facilities. Braz J Infect Dis 2013; 18:21-7. [PMID: 24029437 PMCID: PMC9425259 DOI: 10.1016/j.bjid.2013.04.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Revised: 03/26/2013] [Accepted: 04/11/2013] [Indexed: 12/05/2022] Open
Abstract
Background Health care-associated infection remains a significant hazard for hospitalized patients. Hand hygiene is a fundamental action for ensuring patient safety. Objective To promote adoption of World Health Organization Hand Hygiene Guidelines to enhance compliance among doctors and nurses and improve patient safety. Methods The study design was a cross sectional intervention in a Federal Teaching Hospital South-eastern Nigeria. Interventions involved training/education; introduction of hand rub; and hand hygiene reminders. The impact of interventions and hand hygiene compliance were evaluated using World Health Organization direct observation technique. Results The post-intervention hand hygiene compliance rate was 65.3%. Hand hygiene indications showed highest compliance rate ‘after body fluid exposure’ (75.3%) and ‘after touching a patient’ (73.6%) while the least compliance rate was recorded ‘before touching a patient’ (58.0%). Hand hygiene compliance rate was significantly higher among nurses (72.9%) compared to doctors (59.7%) (χ2 = 23.8, p < 0.05). Hand hygiene indication with significantly higher compliance rate was “before clean/aseptic procedure” (84.4%) (χ2 = 80.74, p < 0.05). Out of the 815 hand hygiene practices recorded 550 (67.5%) were hand rub action. Conclusions hand hygiene campaigns using the World Health Organization tools and methodology can be successfully executed in a tertiary health facility of a low-income setting with far reaching improvements in compliance.
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Affiliation(s)
- Chigozie Jesse Uneke
- Department of Medical Microbiology/Parasitology, Faculty of Clinical Medicine, Ebonyi State University, Abakaliki, Nigeria.
| | - Chinwendu Daniel Ndukwe
- Department of Community Medicine, Faculty of Clinical Medicine, Ebonyi State University, Abakaliki, Nigeria
| | - Patrick Gold Oyibo
- Department of Community Medicine, Faculty of Clinical Medicine, Delta State University, Abraka, Nigeria
| | - Kingsley Onuoha Nwakpu
- Department of Medical Microbiology/Parasitology, Faculty of Clinical Medicine, Ebonyi State University, Abakaliki, Nigeria
| | - Richard Chukwuka Nnabu
- Department of Community Medicine, Faculty of Clinical Medicine, Ebonyi State University, Abakaliki, Nigeria
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Hughes KA, Cornwall J, Theis JC, Brooks HJL. Bacterial contamination of unused, disposable non-sterile gloves on a hospital orthopaedic ward. Australas Med J 2013; 6:331-8. [PMID: 23837081 DOI: 10.4066/amj.2013.1675] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Non-sterile disposable gloves are used on large hospital wards, however their potential role as a vehicle for pathogen transmission has not been explored in this setting. AIMS This study investigates glove use on a hospital orthopaedic ward to examine whether pathogen contamination occurs prior to contact with patients. METHOD Glove samples were aseptically removed from boxes on a hospital orthopaedic ward on opening and days 3, 6 and 9 thereafter. Following elution of bacteria and viable counts, glove isolates were identified by standard techniques and 16s rDNA sequencing. Methicillin resistance of staphylococci was determined by disc diffusion, Epsilon tests and PCR. Gloves were inoculated to determine two isolate survival rates. RESULTS Total bacterial counts ranged from 0 to 9.6 x 10(3) cfu/glove. Environmental bacteria, particularly Bacillus species, were present on 31/38 (81.6%) of samples. Half (19/38) the samples were contaminated with skin commensals; coagulase negative staphylococci were predominant. Enterococcus faecalis , Klebsiella pneumoniae , Pseudomonas sp. or methicillin susceptible Staphylococcus aureus were recovered from 5/38 (13.2%) of samples. Significantly more skin commensals and pathogens were recovered from samples from days 3, 6, 9 than box-opening samples. Staphylococcus epidermidis and Klebsiella pneumoniae inoculated onto gloves remained viable for several days but counts decreased. CONCLUSION Health care workers introduced skin commensals and pathogenic bacteria into glove boxes indicating that unused, non-sterile gloves are potential pathogen transmission vehicles in hospitals. Findings highlight adherence to handwashing guidelines, common glove retrieval practice, and glove-box design as targets for decreasing bacteria transmission via gloves on hospital wards.
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Affiliation(s)
- Kim A Hughes
- Department of Microbiology and Immunology, Otago School of Medical Sciences, University of Otago
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Saunders C, Hryhorskyj L, Skinner J. Factors influencing stethoscope cleanliness among clinical medical students. J Hosp Infect 2013; 84:242-4. [PMID: 23764319 DOI: 10.1016/j.jhin.2013.04.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Accepted: 04/01/2013] [Indexed: 11/27/2022]
Abstract
This study aims to identify current stethoscope hygiene habits and attitudes in a UK medical school setting. Students completed a questionnaire using Likert-scale questions and free-text answers. A total of 308 questionnaires were completed from a potential 750 students (41%); 22.4% of respondents had never cleaned their stethoscope and only 3.9% cleaned their stethoscope after every patient. Significant correlations were identified between cleaning frequency and: others acting as role models (P = 0.001), students having confidence in how to clean stethoscopes (P = 0.001), and students thinking cleaning was important (P = 0.01), thereby highlighting inadequate education and role models as potential problems.
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Affiliation(s)
- C Saunders
- College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK.
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Anargh V, Singh H, Kulkarni A, Kotwal A, Mahen A. Hand hygiene practices among health care workers (HCWs) in a tertiary care facility in Pune. Med J Armed Forces India 2012; 69:54-6. [PMID: 24532935 DOI: 10.1016/j.mjafi.2012.08.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2012] [Accepted: 08/19/2012] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Improper hand hygiene by healthcare workers (HCWs) is responsible for about 40% of nosocomial infections resulting in prolonged illnesses, hospital stays, long-term disability and unexpected high costs on patients and their families, and also lead to a massive additional financial burden on the health-care system. OBJECTIVE To assess knowledge and practices regarding hand hygiene among HCWs of a tertiary health care facility. METHODS A cross sectional, questionnaire and observation based study was carried out in a tertiary care health care facility in Pune. Based on sample size calculations, 100 HCWs working in medical and surgical wards were studied. RESULTS The proportion knowledgeable about hand hygiene practices was 85% and 73% HCWs were of the belief that unclean hands are an important route of cross transmission. WHO guidelines regarding procedure were being followed by 90% for hand washing with soap and water and 64% for alcohol based rubs. Majority preferred hand washing with soap and water over hand rubbing with alcohol based solutions. 21% of HCWs were missing hand hygiene opportunities 1 in 5 times. Heavy workload (38%), non availability (52%) and inaccessibility (9%) of hand hygiene facilities were the common reasons for non-compliance. Availability of 'one time use paper towels' was low (12%). CONCLUSION Inadequate compliance despite knowledge and false sense of security by alcohol based rubs was seen. A multi disciplinary, multifaceted approach is required to tackle issues of non-compliance.
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Affiliation(s)
- V Anargh
- Intern, 166 Military Hospital, C/o 56 APO, India
| | - Harpreet Singh
- Resident, Dept of Community Medicine, AFMC, Pune 411040, India
| | - Aniket Kulkarni
- Resident, Dept of Community Medicine, AFMC, Pune 411040, India
| | - Atul Kotwal
- Director, AFMS (Medical Research), New Delhi, India
| | - Ajoy Mahen
- Professor & Head, Dept of Community Medicine, AFMC, Pune 411040, India
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Oliveira ACD, Silva MDDM, Garbaccio JL. Vestuário de profissionais de saúde como potenciais reservatórios de microrganismos: uma revisão integrativa. TEXTO & CONTEXTO ENFERMAGEM 2012. [DOI: 10.1590/s0104-07072012000300025] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objetivou-se identificar na literatura, artigos sobre a ocorrência de contaminação por microrganismos, em jalecos, aventais e uniformes dos profissionais de saúde, e a similaridade com aqueles associados às Infecções Relacionadas à Assistência à Saúde, considerando o perfil de resistência aos antimicrobianos. Realizou-se busca por artigos nas seguintes bases de dados: MEDLINE, LILACS e SCOPUS, publicados entre 2000 e 2010. Foram selecionados nove artigos. Os estudos evidenciaram a contaminação dos jalecos, aventais e uniformes. Nos estudos analisados, verificou-se a presença de bactérias, principalmente, nos bolsos, punhos e região abdominal. Quanto ao perfil de sensibilidade, verificou-se recuperação de Staphylococcus aureus meticilina resistente, seguidos dos Gram negativos resistentes aos antimicrobianos. Identificou-se semelhança entre as cepas isoladas no vestuário dos profissionais de saúde e aquelas relacionadas à ocorrência de infecções. Assim, jalecos, aventais e uniformes devem ser considerados na cadeia de disseminação de microrganismos resistentes.
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Fernandes CR, Fonseca NM, Rosa DM, Simões CM, Duarte NMDC. Brazilian Society of Anesthesiology Recommendations for Safety in Regional Anesthesia. Rev Bras Anestesiol 2011; 61:668-94, 366-81. [DOI: 10.1016/s0034-7094(11)70077-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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25
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Dolinger DL, Jacobs AA. Molecular Diagnostics and Active Screening for Health Care-Associated Infections: Stepping-Up the Game: Table 1. Lab Med 2011. [DOI: 10.1309/lmh144zoetkvqcju] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Duroy E, Le Coutour X. L’hygiène hospitalière et les étudiants en médecine. Med Mal Infect 2010; 40:530-6. [DOI: 10.1016/j.medmal.2010.02.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Revised: 01/06/2010] [Accepted: 02/12/2010] [Indexed: 11/17/2022]
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Stahl JP. Maximizing positive outcomes for patients with staphylococcal infections. Clin Microbiol Infect 2009; 15 Suppl 6:26-32. [PMID: 19917024 DOI: 10.1111/j.1469-0691.2009.03056.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Maximizing positive outcomes for serious Gram-positive infections, such as those caused by Staphylococcus species, requires an aggressive treatment approach. Although specific approaches will depend upon many factors, the underlying common strategy should recognize the positive contribution of minimizing complications and inpatient treatment duration and the efficient use of healthcare resources, while also focusing on rapid resolution of infection and safety and tolerability. To advance the standard of care for patients, we need to utilize therapies that enable such a range of factors to be improved. Treatment guidelines are useful to establish evidence-based standards of care, but they are updated infrequently and there is currently no pan-European consensus for the treatment of staphylococcal infections. With the benefit of the clinical experience that has been acquired for the most recently licensed antibiotics, together with an appreciation of the appropriate usage of older agents, there are good prospects for achieving positive outcomes earlier and in a greater range of patients with staphylococcal infections, and treatment guidelines should be updated regularly to reflect this.
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Affiliation(s)
- J-P Stahl
- Infectious Diseases Centre, Grenoble University, Grenoble, France.
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28
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"Can religious icons be vectors of infectious diseases in hospital settings?". Am J Infect Control 2009; 37:861-3. [PMID: 19541389 DOI: 10.1016/j.ajic.2009.03.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2009] [Revised: 03/07/2009] [Accepted: 03/12/2009] [Indexed: 11/23/2022]
Abstract
According to Jewish tradition, Mezuzahs should be affixed on all doorposts leading to communal places. We evaluated the bacterial pathogenic load on the Mezuzah covers in our hospital. Mezuzahs were sampled in all hospital departments, and cultures were carried out. Serving as a control group, door handles belonging to the same departments were tested as well. Most samples harbored potential pathogens. Few cultures were positive in the control group, demonstrating that regular disinfection is carried out, but apparently religious artifacts are overlooked.
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Alleyne S, Hussain A, Clokie M, Jenkins D. Stethoscopes: potential vectors of Clostridium difficile. J Hosp Infect 2009; 73:187-9. [DOI: 10.1016/j.jhin.2009.05.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2009] [Accepted: 05/28/2009] [Indexed: 11/25/2022]
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Tai JWM, Mok ESB, Ching PTY, Seto WH, Pittet D. Nurses and physicians' perceptions of the importance and impact of healthcare-associated infections and hand hygiene: a multi-center exploratory study in Hong Kong. Infection 2009; 37:320-33. [PMID: 19636497 DOI: 10.1007/s15010-009-8245-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2008] [Accepted: 12/18/2008] [Indexed: 10/20/2022]
Abstract
BACKGROUND Hand hygiene promotion for patient safety is a challenge worldwide, and local data are critical to tailor strategies to the setting. METHODS This is a cross-sectional study of nurses and physicians providing direct patient care in four hospitals in Hong Kong using an anonymous questionnaire survey. Cognitive factors related to hand hygiene and the perception of effective interventions promoting hand hygiene were assessed. RESULTS The overall response rate was 59.3%. Among respondents, 70% of the nurses and 49% of the physicians perceived that over 15% of patients would suffer from healthcare-associated infections. A total of 79% of the nurses and 68% of the physicians believed that more than 5% of patients would die as a result of healthcare-associated infection. A total of 60% of the nurses and 46% of the physicians acknowledged that over 75% of healthcare-associated infections could be prevented by optimal hand hygiene practices, although 36% of the nurses and 23% of the physicians claimed that six to ten hand cleansing times per hour would be necessary. Bivariate analysis showed significant differences between professionals in self-reported performance. A multivariate regression model revealed that perceived behavioral control and subjective norms were the most important factors associated with the nurses and physicians' self-reported hand hygiene performance. However when gender was taken into account among professionals, subjective norms was the only consistent one. CONCLUSION These results could be used as a tool to create goal-specific strategies for motivating hand hygiene amongst nurses and physicians in Hong Kong, with appropriate promotional interventions delivered to the different professional groups and specialties.
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Affiliation(s)
- J W M Tai
- Infection Control Unit, Queen Mary Hospital, Pokfulam Road, Hong Kong, Special Administrative Region of China.
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31
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Carvalho CMRS, Madeira MZDA, Tapety FI, Alves ELM, Martins MDCDC, Brito JNPDO. Aspectos de biossegurança relacionados ao uso do jaleco pelos profissionais de saúde: uma revisão da literatura. TEXTO & CONTEXTO ENFERMAGEM 2009. [DOI: 10.1590/s0104-07072009000200020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
O estudo objetivou analisar a literatura publicada a respeito dos aspectos da biossegurança relacionados ao uso do jaleco pelos profissionais da saúde. Trata-se de uma revisão narrativa da literatura publicada no período de 1991 a 2008. Utilizou-se as bases de dados MEDLINE, LILACS e SciELO, sendo selecionados 22 artigos que foram agrupados para análise considerando os enfoques priorizados em: infecções cruzadas causadas por jalecos; jalecos contaminados; flora bacteriana em jalecos dos profissionais de saúde. O jaleco foi abordado como fonte de contaminação e como equipamento de proteção individual na prevenção das infecções. Portanto, são necessárias campanhas educativas no sentido de orientar os profissionais de saúde sobre o uso de jaleco.
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Cantrell D, Shamriz O, Cohen MJ, Stern Z, Block C, Brezis M. Hand hygiene compliance by physicians: marked heterogeneity due to local culture? Am J Infect Control 2009; 37:301-5. [PMID: 18834749 DOI: 10.1016/j.ajic.2008.05.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2007] [Revised: 05/06/2008] [Accepted: 05/06/2008] [Indexed: 11/28/2022]
Abstract
BACKGROUND Physician compliance with hand hygiene guidelines often has been reported as insufficient. METHODS The study was conducted in 2 hospitals (Hadassah Ein Kerem [EK] and Mt Scopus [MS]) in Jerusalem, Israel. Covert observations were conducted during morning rounds by trained observers. The data were recorded as the percentage of times that hand hygiene was applied out of the total contacts with patients. After the observational step, an intervention-providing an alcohol gel and encouraging its use-was instituted in several wards. RESULTS Physicians' compliance with hand hygiene averaged 77% at MS and 33% at EK (P < .001), and was characterized by a marked additional heterogeneity among wards. Rates of adherence ranged from as low as 4% in a gynecology ward to as high as 96% in a neonatal unit. Availability of a handwashing basin in the room and seniority status of the physician were associated with higher compliance rates but explained only a small part of the variation. Compliance improved significantly in 2 wards exposed to the intervention. CONCLUSION The remarkable heterogeneity in physicians' hand hygiene compliance among sites within the same institution is consistent with an important role of the local ward culture.
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Affiliation(s)
- Dror Cantrell
- Center for Clinical Quality and Safety, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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Lecat P, Cropp E, McCord G, Haller NA. Ethanol-based cleanser versus isopropyl alcohol to decontaminate stethoscopes. Am J Infect Control 2009; 37:241-3. [PMID: 19185394 DOI: 10.1016/j.ajic.2008.08.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2008] [Revised: 07/31/2008] [Accepted: 08/06/2008] [Indexed: 10/21/2022]
Abstract
Approximately 1 in 20 hospital admissions is complicated by a health care-associated infection. Stethoscopes may play a role in spreading nosocomial infections. The objective of this study was to determine the effectiveness of an ethanol-based cleanser (EBC) compared with isopropyl alcohol pads in reducing bacterial contamination of stethoscope diaphragms. Stethoscopes were cultured from medical professionals on 4 medical floors before and after cleaning with either EBC or isopropyl alcohol pads. The numbers of colony-forming units (cfu) grown were compared between the 2 cleaners and to baseline values. A total of 99 stethoscopes were cultured (49 EBC; 50 isopropyl alcohol), and all were positive for growth. After cleaning, 28.28% of the stethoscopes were growth-free (12 EBC; 16 isopropyl alcohol). Cleaning with EBC and isopropyl alcohol pads significantly reduced the cfu counts (by 92.8% and 92.5%, respectively), but neither was found to be statistically superior (F = 1.22; P = .2721). Cleaning a stethoscope diaphragm using either EBC or isopropyl alcohol led to a significant reduction in bacterial growth in culture. As an extension of the hand, a stethoscope should be cleaned with the same frequency as the hands. The simultaneous cleaning of hands and stethoscope may further increase compliance with current standards.
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Mutters R, Nonnenmacher C, Susin C, Albrecht U, Kropatsch R, Schumacher S. Quantitative detection of Clostridium difficile in hospital environmental samples by real-time polymerase chain reaction. J Hosp Infect 2008; 71:43-8. [PMID: 19041162 DOI: 10.1016/j.jhin.2008.10.021] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2008] [Accepted: 10/17/2008] [Indexed: 01/11/2023]
Abstract
C. difficile-associated diarrhoea occurs commonly in hospitals and is a significant cause of morbidity and mortality. Hospital surfaces are often contaminated with nosocomial pathogens and may be responsible for cross-transmission, especially if hardy Gram-positive and spore-forming organisms are involved. The aim of this study was to quantify C. difficile in the hospital environment near C. difficile-positive and -negative patients using a quantitative real-time polymerase chain reaction. A total of 531 samples was collected from the clinical environment and classified into three groups according to patient and ward status for C. difficile. As expected, there were significantly higher counts of C. difficile on the floor and in the near environment of C. difficile patients. However, a significant correlation was found between C. difficile counts on the floor and on the hands of patients and healthcare workers (HCWs) in wards without evidence of C. difficile. This suggests that asymptomatic carriage among patients and HCWs can also contribute towards C. difficile transmission in hospitals. In conclusion, C. difficile can be transmitted via personal contact or via contaminated areas of the hospital environment.
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Affiliation(s)
- R Mutters
- Institute of Medical Microbiology and Hygiene, Philipps University Marburg, Marburg, Germany.
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Ferns T, West S. The art of auscultation: evaluating a patient's respiratory pathology. ACTA ACUST UNITED AC 2008; 17:772-7. [PMID: 18825853 DOI: 10.12968/bjon.2008.17.12.30307] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
This article considers national policy drivers promoting the development of advanced assessment skills and practical procedures for the safe and effective use of the stethoscope in the clinical area. The evidence base underpinning effective use of the stethoscope in clinical practice is explored, including the preparation of the patient and the environment, applying infection control policies, and placing an emphasis on privacy and dignity. This is followed by a practical guide to auscultation technique of the respiratory system for nurses developing advanced practice skills.
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Affiliation(s)
- Terry Ferns
- Department ofAcute and Continuing Care, University of Greenwich, London
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Horlocker TT, Wedel DJ. Infectious complications of regional anesthesia. Best Pract Res Clin Anaesthesiol 2008; 22:451-75. [DOI: 10.1016/j.bpa.2008.06.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Ozyazicioğlu N, Arikan D. The effect of nurse training on the improvement of intravenous applications. NURSE EDUCATION TODAY 2008; 28:179-85. [PMID: 17445954 DOI: 10.1016/j.nedt.2007.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2006] [Revised: 12/20/2006] [Accepted: 03/02/2007] [Indexed: 05/15/2023]
Abstract
This research was performed to determine the effect of training on intravenous applications. The research was conducted between March 2004 and December 2004 as a single group pre-test, post-test, quasi- experimental design. The study population was composed of 45 volunteer nurses working in pediatric clinics of three hospitals at Erzurum city, in eastern Turkey. There was no sampling: the research was started with 45 nurses and completed with 40 nurses. Results of the research indicate that after the nurse training there has been a noticeable improvement in the following practices: intravenous peripheral catheter application skills, handwashing, glove wearing, antiseptic use, collaboration with the child, choice of cannula appropriate for the treatment, adequate securement with tape, record keeping of cannula placement time, informing the parents of the reason for cannula placement and the duration of treatment, informing the parents that it will not affect the mobility of the child and that the nurse can be notified in case of pain or discomfort following the procedure. These results may be useful in determining the weaknesses in the nurses' performance and planning their training accordingly.
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Affiliation(s)
- Nurcan Ozyazicioğlu
- Department of Child Health Nursing, College of Nursing, Uludağ University, 16059 Bursa, Turkey
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Harling R, Turbitt D, Millar M, Ushiro-Lumb I, Lacey S, Xavier G, Pope J, Ijaz S, Teo CG. Passage from India: an outbreak of hepatitis B linked to a patient who acquired infection from health care overseas. Public Health 2007; 121:734-41. [PMID: 17573083 DOI: 10.1016/j.puhe.2007.03.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2006] [Revised: 02/08/2007] [Accepted: 03/01/2007] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To investigate a nosocomial and community outbreak of hepatitis B to establish how the infections might have occurred. STUDY DESIGN Descriptive study. METHODS Four cases of hepatitis B who had stayed in hospital during their incubation periods, a case in one of their household contacts, and three further cases in the community were all linked to a patient who had been infected during a renal transplant in India. Medical records from cases were reviewed to extract information about risk factors for infection. Working practices were reviewed to determine how nosocomial transmissions might have occurred. 'Look-back' exercises were conducted to identify and follow-up other patients and staff who might also be at-risk of infection. Hepatitis B viral sequences from all cases were examined to determine whether they were related. RESULTS Viral DNA sequences from all nine cases were identical. The primary case had an extremely high viral load due to underlying immunosuppression. Three of the nosocomial transmissions occurred whilst the primary and secondary cases shared general medical wards; two whilst the primary case was in standard isolation. No clear routes of infection were identified. The fourth was associated with a failure of infection control in operating theatres. CONCLUSIONS Invasive medical procedures in high-prevalence countries carry a clear risk of blood borne viral infections. There is a need for much better awareness of this risk, both among patients who are considering travelling for treatment, and the health professionals who will be caring for them on their return. Infections may be preventable through hepatitis B vaccination. Patients admitted to hospital following invasive medical procedures in high-prevalence countries should be nursed with stringent infection control measures until blood borne viral infections can be excluded. However, patients with hepatitis B who are highly infectious may transmit the virus despite high standards of infection control.
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Affiliation(s)
- Richard Harling
- UCL Centre for Infectious Disease Epidemiology, Department of Primary Care and Population Sciences, Royal Free Campus, Rowland Hill Street, London NW3 2PF, UK.
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Sacar S, Turgut H, Kaleli I, Cevahir N, Asan A, Sacar M, Tekin K. Poor hospital infection control practice in hand hygiene, glove utilization, and usage of tourniquets. Am J Infect Control 2006; 34:606-9. [PMID: 17097459 DOI: 10.1016/j.ajic.2006.02.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2006] [Revised: 02/17/2006] [Accepted: 02/20/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND Hospital-acquired infection often occurs because of lapses in accepted standards of practice on the part of health care personnel. The aim of this study is to attract attention on poor hospital infection control practice in venepuncture and use of tourniquets and emphasize the importance of hand hygiene. METHODS Overall compliance with hygiene during usage of tourniquets and routine patient care before and after implementation of a hospital infection control measures was evaluated. RESULTS According to the questionnaire, only 26.9% of respondents always washed their hands both before and after venepuncture. In the second step of the study, based on direct observation, hands were washed both before and after venepuncture on only 41 (45.1%) occasions. Failure to remove gloves after patient contact was observed on 23.1% occasions. CONCLUSION Our survey reveals poor infection control practice in hand hygiene, glove utilization, and usage of tourniquets and the implementation of infection control measures produced a moderate improvement in compliance with them.
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Affiliation(s)
- Suzan Sacar
- Department of Infectious Diseases and Clinical Microbiology, Pamukkale University Faculty of Medicine, Department of Infectious Diseases, Turkey.
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Hausermann P, Widmer A, Itin P. Dermatoscope as Vector for Transmissible Diseases – No Apparent Risk of Nosocomial Infections in Outpatients. Dermatology 2006; 212:27-30. [PMID: 16319470 DOI: 10.1159/000089018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2004] [Accepted: 03/19/2005] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To determine nonpathogenic and potentially pathogenic bacterial growth isolated from dermatoscopes of dermatologists using oil as contact medium in the daily routine at two outpatient sections in Switzerland. METHODS We investigated the microbiologic colonization of dermatoscopes (Dermatoskop Delta 10, Heine Optotechnik, or Dermogeniusbasic, Rodenstock) during routine use in the outpatient sections of the Departments of Dermatology at the University of Basel and Kantonsspital Aarau. 112 swabs (4 from Aarau, 108 from Basel) taken under standardized conditions were microbiologically worked up in the same laboratory. Oil (101) and 63% isopropyl alcohol (11) were used as contact medium. RESULTS 39 of 112 swabs showed no bacterial growth. 73 of 112 showed growth of nonpathogenic bacteria (skin flora). Additionally to the cultivation of nonpathogenic bacteria, 3 swabs showed growth of oxacillin-sensitive potentially pathogenic Staphylococcus aureus. Of 11 swabs taken after using 63% isopropyl alcohol as a contact medium, 6 revealed no bacterial growth and 5 showed the growth of skin flora. CONCLUSIONS The potential risk of nosocomial infection related to the routine use of dermatoscopes in outpatients is small, and the use of oil as a contact medium for dermatoscopy to enhance the optical quality seems to be unproblematic.
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Affiliation(s)
- P Hausermann
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
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Samuel R, Almedom AM, Hagos G, Albin S, Mutungi A. Promotion of handwashing as a measure of quality of care and prevention of hospital-acquired infections in Eritrea: the Keren study. Afr Health Sci 2005; 5:4-13. [PMID: 15843125 PMCID: PMC1831903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
UNLABELLED A complex interplay of cognitive, socio-economic and technical factors may determine hand-washing practice among hospital-based health workers, particularly doctors, regardless of the location of the country or hospital they work in. OBJECTIVES To assess quality of care with respect to handwashing practice as a routine measure of infection prevention in Keren hospital, a provincial referral hospital, second largest in Eritrea; with a view to putting in place quality standards and effective means of monitoring and evaluation. DESIGN Qualitative study with a participatory and iterative/dynamic design. METHODS Semi-structured interviews and focus group discussions were held with 34 members of the hospital staff; and a total of 30 patients in the medical, surgical and obstetric wards were interviewed. Direct observation of handwashing practice and facilities were also employed. RESULTS Although only 30% of health workers routinely washed their hands between patient contact, the study revealed genuine interest in training and the need to reward good practice in order to motivate health workers. Educational intervention and technical training resulted in significant improvements in health workers' compliance with hospital infection prevention standards. Patient satisfaction with health workers' hygiene practices also improved significantly. CONCLUSION Hospital-based health workers' handwashing practice needs to improve globally. There is no room for complacency, however, in Eritrea (as indeed in other African countries) where public health services need to keep patients' welfare at heart; particularly with respect to women in childbirth, as mothers continue to bear the lion's share of post-war rebuilding of lives, livelihoods, and the country as a whole.
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Affiliation(s)
- Rigbe Samuel
- Nursing and Quality of Health Care Services, Ministry of Health, Asmara, Eritrea
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Abstract
BACKGROUND The purpose of this study was to compare the frequency of glove defects for nonlatex surgical gloves while surgeons performed routine surgery and to evaluate surgeons' satisfaction with nonlatex sterile gloves. METHODS Two brands of latex gloves and 6 brands of nonlatex gloves were tested. Gloves were collected at the end of each surgical procedure and tested for visual defects and barrier integrity using an automated calibrated water test machine consistent with FDA's recommended standards. A total of 6386 gloves used by 101 surgeons and 164 residents representing 15 surgical services were included in the analysis. RESULTS Higher after-use defect rates occurred in nonlatex surgical gloves than in latex gloves. Higher times of use were related to higher defect rates for some surgical specialties, and both surgeons and residents were less satisfied with nonlatex surgical gloves. CONCLUSION Intact latex and nonlatex surgical gloves provide adequate barrier protection. Nonlatex surgical gloves have higher failure rates and lower user satisfaction than latex gloves do. Both nonlatex and latex gloves should be changed after 2 to 3 hours of use because the barrier of either type of glove becomes compromised with extended use.
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Affiliation(s)
- Denise M Korniewicz
- University of Miami School of Nursing, School of Medicine, Department of Surgery and Epidemiology, Coral Gables, FL 33124, USA.
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Raza MW, Kazi BM, Mustafa M, Gould FK. Developing countries have their own characteristic problems with infection control. J Hosp Infect 2004; 57:294-9. [PMID: 15262389 DOI: 10.1016/j.jhin.2004.03.019] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2003] [Accepted: 03/09/2004] [Indexed: 11/25/2022]
Abstract
Infection control in developing countries differs markedly from that in the developed countries. It is important that both local and international authorities take these differences into account when formulating policies for use in developing countries. This review examines these issues and sets out some suggestions for improvements. The advantages of involving local experts in the development of such policies are emphasized.
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Affiliation(s)
- M W Raza
- Department of Microbiology, Freeman Hospital, Freeman Road, Newcastle upon Tyne N7 7DQ, UK.
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Youʼre Not as Clean as You Think! Reg Anesth Pain Med 2003. [DOI: 10.1097/00115550-200309000-00003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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